Carpal Tunnel Syndrome, other RSIs and the Jeweler

Carpal tunnel syndrome is only one of many kinds of repetitive strain injuries (RSIs) and cumulative trauma disorders (CTDs). RSI, CTD and "overuse syndrome" are reasonably interchangeable in meaning. Carpal tunnel syndrome is, however, the most common "compression neuropathy" in the arms and hands (Harter 488). Injuries to the arms and hands are on the increase in North America (Kasdan and McElwain 539).

RSI and CTD

RSIs are chronic injuries that may result from repeated actions and can cause intense pain and suffering. Surgery may be necessary to correct some injuries. Bradley defines RSIs and CTDs as disorders of the "nerves, muscles, tendons and bones that are caused, precipitated, or aggravated by repeated exertions of movements of the body" (548).

Ramazzini writes of a notary friend who "used to spend his whole life continually engaged in writing and he made a good deal of money by it; first he began to complain of intense fatigue in the whole arm, but no remedy could relieve this, and finally the whole right arm became completely paralyzed. In order to offset this infirmity he began to train himself to write with the left hand, but is was not very long before it too was attacked by the same malady" (Ramazzini 423).

In the past many of the occupational CTDs were called by the occupation in which they were often found. Housemaid's knee, tennis elbow and gamekeeper's thumb are examples.

The recent tendency in the medical field has been to eliminate terms that are job-related and replace them with anatomically-based terms. While gamekeeper's thumb still happens to people, most patients are not gamekeepers these days. Same for the other occupationally named disorders.

There were once over 50 recognized and described conditions of the hands and wrists alone, called "occupational neuroses," often "cramps," which included: diamond cutter's cramp, gold worker's cramp, hammerer's cramp, seamstress' cramp, stone cutter's cramp, scissor sharpener's cramp, money counter's cramp and telegrapher's cramp (Cherniack 380-381).

Certain similar conditions such as "writer's cramp" are psychiatric in nature according to some sources. Waldron, for instance, says that there are no physical manifestations or abnormalities in writer's cramp, that most patients whose jobs depend on their being able to write are obsessional. Waldron wonders why so many are told to seek a different profession rather than being referred for psychiatric help, as one would expect to be the case if the condition was just in the mind (188). Others describe a very real physical inflammation with writer's cramp and suggest the term "tenovaginitis" instead. Several authors make the point that CTDs have always been with us and that what is occurring now is a recognition of the complex mixtures of damage to the upper arms and body that we do to ourselves by how we move, sit, stand and work (Cherniack 380).

CTDs happen in some industries in great numbers. In the poultry industry, CTD cases can be as high as 129 cases per 100 workers per year. Similar rates have been found in manufacturing, assembly and service industries. Bradley notes that jobs with high repetitiveness and force (such as hammering) have high rates of CTD injury (Bradley 548).

Occupations similar to jewelry making that have higher rates of CTDs include buffing machine operation and electronics assembly. Sometimes the adoption of a new tool or way of doing things can cause an epidemic of a new type of CTD injury; for instance, 1987 saw the first reports of "pricer palsy," an ulnar nerve entrapment caused by using the new bar code reading equipment in supermarkets. By the time enough reports and damage to users had occurred to cause changes to avoid the problem, it had cost millions of dollars to the supermarket industry and injured many people (Morse 424).

Three Characteristics of Jobs Affected

Three characteristics of a job have been linked to chronic occupational disorders that may affect all parts of the body: the repetitiveness of the job, how much force is used in it, and the posture needed to do the job. Other linked factors include mechanical stress, working in high or low temperatures, the use of gloves, and hand tool use. Actions linked with developing CTDs include repetitive ones, reaching down and behind, inward or outward rotation of the forearm with a bent wrist, extending the palm, and pinching motions of the hand. Stress and pressure on the base of the palm, on the palm side of the fingers and on the sides of the fingers are also associated with CTDs (Bradley 549-50).

Other things associated with developing such an injury include the performance of unaccustomed work, a return to work after being absent, localized strain and blunt trauma (Tver and Anderson 204). Most cases of carpal tunnel syndrome occur between the ages of 40 and 60 years (Moore 750).

If you are experiencing numbness, tingling in the fingers or actual pain in your wrist or other part of your arms or shoulders, you should check it out with your doctor. Sometimes other conditions which are far more serious can cause symptoms similar to RSIs. You may need a specialist who is current in nerve conduction studies, as well as in reading test results, to properly benefit from an evaluation about an RSI injury (Corwin and Kirzinger 402-403).

If you are sore when you do something, then do something else for a while, and maybe talk to a specialist about how you work, to figure out less damaging ways of doing things. Note that CTDs often partially result from, or are exacerbated by, people's activities outside of the work environment. Sports activities in concert with work repetitions may be particularly bad. And as you age you can hurt yourself doing things that were once easy for you. Therefore, examine your actions in holistic terms, rather than looking at your work activities in isolation.